International Journal for Equity in Health 2012, 11:65
doi:10.1186/1475-9276-11-65

Published: 1 November 2012

Abstract

Introduction

Family (i.e., unpaid) caregiving has long been thought of as a ‘woman’s issue’, which
ultimately results not only in gendered, but also financial and health inequities.
Because of this, gender-based analyses have been prioritized in caregiving research.
However, trends in current feminist scholarship demonstrate that gender intersects
with other axes of difference, such as culture, socio-economic status, and geography
to create diverse experiences. In this analysis we examine how formal front-line palliative
care providers understand the role of such diversities in shaping Canadian family
caregivers’ experiences of end-of-life care. In doing so we consider the implications
of these findings for a social benefit program aimed at supporting family caregivers,
namely the Compassionate Care Benefit (CCB).

Methods

This analysis contributes to a utilization-focused evaluation of Canada’s CCB, a social
program that provides job security and limited income assistance to Canadian family
caregivers who take a temporary leave from employment to provide care for a dying
family member at end-of-life. Fifty semi-structured phone interviews with front-line
palliative care providers from across Canada were conducted and thematic diversity
analysis of the transcripts ensued.

Results

Findings reveal that experiences of caregiving are not homogenous and access to services
and supports are not universal across Canada. Five axes of difference were commonly
raised by front-line palliative care providers when discussing important differences
in family caregivers’ experiences: culture, gender, geography, lifecourse stage, and
material resources. Our findings reveal inequities with regard to accessing needed
caregiver services and resources, including the CCB, based on these axes of difference.

Conclusions

We contend that without considering diversity, patterns in vulnerability and inequity
are overlooked, and thus continually reinforced in health policy. Based on our findings,
we demonstrate that re-framing categorizations of caregivers can expose specific vulnerabilities
and inequities while identifying implications for the CCB program as it is currently
administered. From a policy perspective, this analysis demonstrates why diversity
needs to be acknowledged in policy circles, including in relation to the CCB, and
seeks to counteract single dimensional approaches for understanding caregiver needs
at end-of-life. Such findings illustrate how diversity analysis can dramatically enhance
evaluative health policy research.